Community Health Issue Nursing and Term Paper

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The team analyzed samples for carcinogen-DNA adducts, biomarkers associated with increased cancer risk, and cotinine, a measure of secondhand tobacco smoke exposure. Based on prior findings in animal models, scientists believe only one-tenth of the dose of PAH passes from the mother to fetus through the placenta. Even so, the investigators found that newborns incurred DNA damage at a rate slightly higher than their mothers" (Wood, 2006). In other words, even if a mother does not smoke, the nurse may wish to ask about the patient's partner's smoking habit, or if the patient works in a smoke-containing environment.

The study also found that "detectable adducts were identified in 45% of the newborns and 42% of the mothers. Newborn cotinine levels were higher, 47% in the infants versus 44% detectable in the mothers," despite the screening effect of the placenta (Wood, 2006). "Researchers said the fetal concentration may be due to a decreased ability to clear the biomarker during development, transfer from the maternal blood and additional exposure to the chemicals after swallowing amniotic fluid" (Wood, 2006). Explaining to expectant mothers the imperative nature of smoking cessation, and stressing the need to limit the exposure to second-hand smoke from friends, partners, and in the workplace environment as part of healthy prenatal self-care is thus also crucial for nurses, to minimize the risk of exposure for the health of both the baby and the mother.

Sattler stresses that while a nurse cannot protect a patient from all environmental risks, nurses must "put some new tools in our nursing toolbox" in terms of preventative strategies, such as informing patients about environmental health risks to increase self-care, and underlining the need that taking effective damage-control strategies, even while perfect protection is impossible is still better than taking no such steps at all (Sattler, 2004-2005: 2). Of course, to create the most effective strategy to minimize patient exposure, the nursing profession as a whole must take on an expanded role in improving the health of the food people eat, and the sorts of chemical substances used in manufacturing and agriculture.

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Until then, nurses must be able "to identify and use diagnostic labels that describe responses to challenges of toxic exposure, contamination, pollution, infection, and violence in society. Nursing needs to enlarge its perspective to include diagnoses that address the environmental domain on a broad level" (Green et al., 2003: 1). One might add, not simply in nursing diagnosis, but also treatment. It is not enough to spot the effects of toxic exposure after they have occurred. When giving advice to a pregnant woman about her diet, a nurse may need to guide the patient away from mercury-containing fish, and provide advice about improving the quality of her environment.

The Orem model is especially useful because it stresses the need for nursing intervention to ideally touch off a new program of improved self-care for the patient in acts of daily life, such as environmental monitoring of avoidable toxins and dietary alternation. The nurse facilitates increased self-care by providing knowledge. But because a patient will never have perfect knowledge of possible risks to his or her health from toxins, a nurse has a critical role as an educator. As the risks from environmental toxins continue to escalate, so will the nurse's role in patient education as well as patient monitoring.

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